198602422-7-10-2025-28-AS-DSIS-DJLNDT-20250715102253

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 07/10/2025
Date Signed: 07/10/2025 10:53:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250521091528

FACILITY NAME:	PEOPLE'S CARE VIOLA		FACILITY NUMBER:	198602422
ADMINISTRATOR:	CHRISTIAN RODRIGUEZ		FACILITY TYPE:	737
ADDRESS:	1605 VIOLA PL		TELEPHONE:	(909) 671-4184
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	3	CENSUS: 3	DATE:	07/10/2025
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Jacob Candias - Assistant Administrator Jai Seymour - House Lead		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not provide adequate supervision to client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint investigation to deliver findings for the allegation listed above. LPA met with Jai Seymour, House Lead and explained the purpose of the visit. Shortly after, Jacob Candias, Assistant Administrator arrived to assist LPA.

The investigation consisted of the following: On 5/29/2025, LPA toured the facility and obtained copies of the staff/client roster and Client #1 (C1) pertinent files related to the allegation. LPA interviewed Staff #1-Staff #4 (S1-S4), Client #3 (C3) and attempted to interview Client #1 (C1) on the phone but declined to speak with LPA. On 06/13/2025, LPA interviewed Staff #5 (S5) on the phone and attempted to interview Client #1 (C1) but C1 refused to speak with LPA. On 07/03/2025, LPA interviewed Client #2 (C2) on the phone and attempted to interview Client #1 (C1) but refused.

During today’s visit, LPA obtained copies of the staff/client roster and delivered findings.
***CONTINUED ON LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250521091528

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE VIOLA	FACILITY NUMBER: 198602422
	VISIT DATE: 07/10/2025

NARRATIVE

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The investigation revealed the following:

In regards to the allegation "Staff did not provide adequate supervision to client in care", It is alleged that on 5/16/2025, C1 took (2) serving packets of Extra Strength Tylenol under the supervision of a Day Program staff member and that C1 allegedly obtained the ES Tylenol pills during an outing with a one-on-one staff member at the facility. (5) out of (5) staff interviewed denied the allegation. All staff interviewed confirmed that C1 has a one-on-one staff member monitoring them closely and medications are kept secure. On May 16, 2025, day program staff reported to the facility that C1 was taken to the ER for chest pains after admitting to taking (4) packets of 500mg ES Tylenol pills in the day program’s restroom. At the ER, day program staff found (2) more packets in C1's backpack. When S5 arrived at the ER, C1 claimed to have obtained the Tylenol from a trip with day program staff and not the facility staff. However, other staff interviewed stated C1 said they got the pills from a man in the transportation van. LPA attempted to interview C1 three times, but C1 refused to be interviewed. (2) clients interviewed were unaware of the incident and felt there was enough staff to supervise and meet their needs. Clients interviewed also indicated they like the staff and feel comfortable at the facility. LPA observed that the medications were stored safely and were inaccessible to clients. Medication Administration Record (MAR) for C1 was reviewed and showed no ES Tylenol was given between 05/05/2025 and 05/16/2025. Additional records reviewed (IBSP 04/15/2025) indicated C1 has a history of fabricating stories and later changing them. Although the Regional Center has not yet finished its report, the SC and QA representatives agreed that their findings are likely to be "inconclusive" due to C1's repeated changes in their story.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was held, and a copy of this report was provided to Jacob Candias, Assistant Administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

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